The dream and the coexistence with the mysterious

From the first day he came home with us, with two days old, Francisco woke up two minutes after we supported him in his crib. I had just taken the tit, I wasn't hungry. So I lifted him up and cradled him in my arms until he fell asleep again. I left him in the crib attached to our bed and he stayed. But after a minute, at most two, he woke up again. With my two previous children it had not happened to me. Nor had it happened to Lau with his previous daughters. So we improvised. We warmed the sheets before supporting it, we lit a nightstand with a t-shirt up to give dim light, lullaby, rhythmic pat on the ass, mimitos on the back. None of the actions were successful, more than circumstantial. The only thing that ended up working was the co-lecho, which I, as a neurologist dedicated to sleep medicine, resisted. But Lau, with the authority that instincts have over reason, told me that everything would be fine.

Sleeping habits are unique to each of us. The transition from wakefulness to sleep requires preparation. During life we build some habits around this transition, as if we need to try out the change of dimension, from the physical world to the dream world. These tricks are weaving a real “liturgy” around the time we go to bed, which over the years becomes a complex of conditions necessary for us to sleep and for us to stay asleep during the night.

Sleep has been a mystery to humanity since the beginning of history, and to a lesser extent, it is still a mystery to humanity today. Because of that human concern to leave no mysteries free of interpretation, sleep, and especially dreams, have succumbed to magical thinking. The Table of Dreams of Ancient Babylon in cuneiform script of more than 4000 years ago, is considered the first document on the interpretation of dreams. From its proper reading, oracular properties could be extracted, meaning that upcoming events could be inferred. In Greek mythology, the dream god Morpheus personified himself and flapped his wings near the sleeper to breathe dreams into him. Then he got into them, taking the shape of the faces that were known. That is to say that every person he dreamed of, was in fact Morpheus taking his form, hence the name. He was punished by Zeus for opening mortals the doors to universal secrets. In the biblical passage Nebuchadnezzar's Dream, based on a disturbing dream of the king, one manages to interpret the future of empires on earth and which of them would be the dilect. As early as the 19th century, Sigmund Freud proposed that dreams were symbolic forms that adopted our repressed urges to surface.

During the twentieth century, especially in the second half, science produced very significant advances in the understanding of the phenomenon of sleep. To begin with, it was possible to discriminate that electroencephalographically distinguishes itself from wakefulness. Also, it has two internal phases that follow each other cyclically: slow sleep (non-REM) and rapid sleep (REM), also called paradoxical. In turn, slow sleep is divided into superficial slow sleep (stages 1 and 2) and deep slow sleep (stage 3). If we add being awake, the three states of consciousness are completed: wakefulness, slow sleep and fast sleep. Each of these stages has a different functioning brain program, involving different structures that also use different combinations of neurotransmitters. And each stage also has specific functions, some we know them and others we don't yet.

During early childhood, Fran continued to require company to fall asleep. To such an extent that he always preferred to fall asleep on the armchair in the living room where there was movement of people, and not go to his room alone. If he woke up in the middle of the night frightened by a nightmare, of course, he would either go to our bed or we had to accompany him in his own, so that he could go back to sleep. Fran always sought co-lecho, direct or symbolic.

Nightmares are a particular type of sleep, which activates intense emotions linked to fear or terror. They occur during rapid sleep (REM), which is the stage in which we dream. In REM sleep, the cortex of the brain is very active, similar to what happens in wakefulness, but the body is turned off, the muscles lose tone. The eyes, under the eyelids, have rapid random movements. We know that only mammals have REM sleep with what is interpreted to be a phenomenon that requires an overdeveloped cerebral cortex like ours. Cetaceans have REM sleep alternately in one hemisphere and then in the other, so as not to lose muscle tone completely and sink into the water.

One of the most accepted theories about why we dream holds that dreams are the consequence of the neuroplasticity process necessary to fix the day's learnings, dismiss what is not relevant and calibrate the decision algorithms that keep us away from dangers, at the lowest possible cost. If today I cross the street distracted and narrowly save myself from being hit by a car, tonight my brain will try to fix that learning so that tomorrow I have a small alarm before crossing the next street and looking everywhere. If learning considers that special strengthening is necessary, it will resort to a nightmare for emotion to act as a fixative of that memory. Blind people have more nightmares than sighted people, possibly in accordance with the fact that the world is more dangerous for them.

It is well known that theoretical learning is also fixed more and better after having slept, and particularly after having dreamed. There are classic studies that prove that a group of people who study and sleep do better on exams than those who study and do not sleep.

In slow sleep (non-REM) deep the brain quite shuts down its activity. It is considered a stage of repair. Lowers heart rate and blood pressure. Here is a process of washing away the remnants of metabolism that occurred during the day. This washing is very important, because these accumulated wastes can be toxic to neurons and favor the occurrence of neurodegenerative diseases. There is a relationship between some sleep disorders that hinder this purification process and with the risk of cognitive impairment.

Also during slow deep sleep, some hormones are secreted. A very important one is growth hormone, so it is essential to take care of this stage in girls, boys and adolescents. Some sleep disorders in children, such as sleep apnea in children, have been correlated with stunted growth.

Science has greatly deepened our knowledge about what happens when we sleep. So much so that in recent decades sleep medicine has been widely developed, a discipline that brings together many health actors from different branches in the prevention, diagnosis and treatment of sleep problems and diseases. The current classification of sleep disorders includes more than 240 different entities. Today we know well that good quality sleep is necessary for our body to balance its physiological functions well and for our mind to remain healthy, both emotionally and cognitively.

Sleep can deteriorate basically for two reasons. Either because there is a disturbance that takes away quantity or quality, or because we don't give it the necessary context and time. In the first case, these are diseases such as respiratory sleep disorders, insomnia, behavioral problems during sleep and many others. In the second, it is about the oversights that we sometimes have with this physiological stage, and that for a few years we have known that we must reverse. How not to allow the use of technologies to detriment our hours of sleep. Sleep deprivation is well known to bring problems in our daily performance, but also that it alters our metabolism. There is a direct relationship between fewer hours of sleep and weight gain, insulin resistance and worsening blood fats. That is why the motto of the Argentine Association of Sleep Medicine on World Sleep Day: “Good quality sleep for a healthy mind and a better life”, where the terms can be understood literally, and which are widely supported by scientific evidence. Better sleep is better quality of life.

Fran is currently still sleeping in the living room armchair. But he's too big enough for us to take him up to his room upa. So we watch him whether or not he has rapid eye movements to know if he is in REM sleep or not, and if he is not, we wake him up a bit as if he is up the ladder. He climbs up completely asleep, held by one of us behind, from the armpits. When he reaches the top, he takes an empty step, as if he were missing one more step to climb. He lies on the bed and keeps sleeping. The habits and tricks related to sleep are particular and unique to each one. And it may be good that we know and care for them, as a true liturgy of one with oneself. They could be understood as an individual adaptation to coexistence with the unknown. And perhaps there is nothing more lonely and personal, than coexistence with the mysterious.

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